Urethral stricture; etiology, presentation, complications, and outcome of management at Gezira state, central Sudan

The objective is to evaluate urethral strictures in term of etiological factors, presentations and management at GHRDS, Gezira State, Central Sudan. One hundred sixty patients, who were diagnosed as urethral stricture, were enrolled in this study. All patients were dealt with through a scientific stratum of a thorough work up and managed according to the EAU guidelines. The bio-data, etiological factors of strictures, presenting symptoms and signs, the pathological types and modalities of treatment were recorded and analyzed. The total number of patients was 160, only two females and the rest were males. The mean age was 46.2 +/- 2 years. The etiological factors were: post-surgical in 67 patients [41.9%], gonococcal urethritis in 48 patients [30%] followed by post traumatic stricture in 28 patients [17.5%]. Concerning the sites 41 [25.6%] patients had bulbar urethral stricture and 24 [15%] with membranous urethra strictures. One hundred forty two [88.8%] patients were treated with visual internal urethrotomy [VIU] and the outcome of treatment was comparable to the literature. The commonest etiological factors for urethral strictures in GHRDS were post-surgery followed by gonococcal urethritis. The outcome of management was comparable

accuracy of FNAC for diagnosis of breast carcinoma in Gezira state, central Sudan

Breast cancer is a leading cause of death in many countries worldwide and breast lesions remain a common diagnostic dilemma. Fine-needle aspiration cytology [FNAC] has been suggested as the most important, first line, minimally invasive procedure in the management of patients with breast lesions. The aim of this study is to assess the diagnostic efficacy of breast FNAC in patients with breast lesions compared with that of the definitive histological diagnosis. This is a hospital-based retrospective study of 112 breast FNAC samples were carried out at Cancer Institute in Medani Gezira state. FNAC findings were correlated with data from histopathology records to determine the sensitivity and specificity of FNAC. Age group of the patients ranged from 26 to 80 years with mean of 42 years. Among the study subjects [112 case], ductal carcinoma is the common hitological linding 83/88 [94%]. According to the cytology, 79% were malignant, 4% were benign and 2% were suspicious. Histological correlation was done in 68 cases. The overall diagnostic accuracy of FNAC was 92.3%, with sensitivity and specificity of 89.2% and 66.5% respectively. FNAC of breast is asimple, cost effective and less traumatic method for diagnosing breast cancer. It is highly sensitive and accurate, and can reduce the needs for open biopsies. It is recommended that FNAC should be used as a first line method for determining the nature of breast lumps

Appropriate induction of t regulatory cells and HBV tolerance: implications for immunotherapy of autoimmune diseases

Opposed to autoimmune diseases the immune tolerance to hepatitis B virus [HBV] has been related to inadequate HBV-specific immune response in addition to the high frequency and over expression of CD4+CD25+T regulatory cells [Treg]: however the exact mechanisms behind the induction of Treg cells in HBV infection are yet to be addressed. Generally Treg cells consist of diverse lymphocyte populations that include CD4+ cells, CD8+ cells, and other minor T cell populations. Several different mechanisms have been evolved to inhibit different immune responses, while many studies imply a cytokine-independent suppressive role of Treg cells in vitro, however accumulating evidence suggest the in vivo immunosuppressive activity of these cells against infection as well as autoimmunity needs cytokines. It is well documented that HBV Dane particles play a vital role in the immunopathogenesis of HBV infection and it has been associated with increased Treg cells which express various memory or activation markers. Based on that, alternative or indirect way of inducing Treg cells which could be a useful tool to ameliorate and/or treat autoimmune diseases is the top research priority. In this review we attempt to emphasize the role of HBV Dane particles[virions] on the induction of Treg cells and immune tolerance in HBV and we also discuss the relevance to search for new immunotherapeutic targets for autoimmune diseases

plasma levels of sodium, potassium and calcium on alcoholic Sudanese subjects

This study was conducted to determine the concentration of sodium, potassium and calcium in the plasma of alcoholic individuals by reference to non-alcoholic individuals. Blood plasma sodium, potassium and calcium levels were studied on 30 chronic alcoholic Sudanese patients compared with 15 non alcoholic subjects as control group. Plasma concentration of sodium and potassium were analyzed using flame photometer methods whereas plasma calcium was analyzed using colorimetric methods. The mean values of plasma sodium, potassium and calcium in the alcoholic individuals were 132.6 mmol/L, 3.4 mmol/L, and 8.5 m/dl respectively, while it was 134.9 mmol/L/ 3.8 mmol/L, and 9.9 mg/dl in non-alcoholic individuals. Which indicate no significant decrease in these plasma electrolytes. Our data shows that, hyponatremia, hypkalemia and hypcalcemia are not common among alcoholics

Evaluation of application of international prostate symptoms score in Sudanese patients with benign prostatic hyperplasia

The purpose of the present study is to assess the reliability and validity of IPSS in pre- and post treatment of Sudanese patients with BPH. In a descriptive prospective study, 350 Sudanese patients with LUTS attended the Urology Department of Gezira Hospital for Renal Diseases and Surgery from September 2003 to April 2006. They were interviewed by urologists and answered the International Prostate Symptom Score [IPSS] questionnaire. Clinical work up was done for all patients, only patients with benign hyperplasia were included in the analysis. Europeans guidelines were adopted in the management and the out come was also subjected to IPSS evaluation. The most common voiding symptoms were weak stream [93% of subjects], followed by intermittency [57%] and hesitancy [54%]. The most prevalence of storage symptoms was nocturia [87% of subjects], followed by frequency [73%], urgency [64%]. 64% of the study subjects presented with severe IPSS, 33% with moderate IPSS, while only 3% of the patients presented with mild IPSS. Digital rectal examination [DRE] was done to all study subjects. There was no significant correlation between DRE and IPSS reported. The postoperative IPSS post treatment follow up was mild in 87%, moderate in 4% and sever in 9% of the patients. Our study indicates that IPSS is informative and reproducible in assessment of patients with BPH

Prostate specific antigen versus digital rectal examination as screening for ca prostate in Sudanese patients

The aim of this study is to compare the value of digital rectal examination [DRE] and prostate specific antigen [PSA] determination in the detection of prostate cancer among Sudanese patients presenting with lower urinary tract symptoms [LUTS]. A prospective study was carried out in Gezira Hospital for Renal Diseases and Surgery in the period of June 2003- May 2005. Patients presenting with LUTS, had been screened for prostate cancer using PSA and DRE examination.. Serum PSA and DRE were measured in all patients. Trans rectal biopsy was performed if the PSA was over 4ng and /or abnormal DRE. A total of 124 elderly male pa3ents presenting with lower urinary tract symptoms [LUTS], 140 of them were at last diagnosed as benign prostate hyperplasia [BPH] and 54 patients were been confirmed with prostate cancer [PCa]. Their mean age was 65 years [range 45-20]. Elevated level of PSA [> 4 ng/ml] was found in all the patients with prostate cancer [n= 54] and 68.6% [n= 26] of 4PH patients. The rate of prostate cancer detection showed to be 25.7% for PSA > 4ng/ml, 13.31% for abnormal [positive] finding of DRE, and 27.8% for combination of the positive DRE and PSA > 4 ng/ml. The rate of 4PH detec3on showed to be 68.6% for PSA > 4ng/ml, 28.6% for positive finding of DRE, and 4.1% for combination of the positive DRE and PSA > 4 ng/ml. It was found that PSA determination detects a considerable proportion of tumors missed by DRE. And the combination of PSA and DRE escalates the probability of prostate cancer detection

anti-inflammatory properties of interleukin 18 binding protein in rheumatoid arthritis

Interleukin-18 binding protein [IL-18BP] is functioning as a natural anti-inflammatory and immunosuppressive molecule by neutralizing the effects of IL-18 during inflammation. This study aimed to identify the role of IL-18BPa in the regulation of immune responses associated with the pathogenesis of RA. 65 RA patients, 22 OA patients, and 40 sex and age matched healthy donors were enrolled in this study. Synovial specimens were obtained through synovectomy or arthroscopic procedures. SFMC and PBMC were prepared by using Ficoll-Hypaque separation procedure. Superarray analysis was used to measure the expression profile of immune-related genes in normal PBMC treated with recombinant human IL-18BPa. The mRNA levels of Th1 and Th2 cytokines were measured by Real-time PCR, and the protein levels of IFN-gamma, IL-4 were detected by ELISA. SuperArray analysis of immune related gene expression profile in normal PBMC treated with IL-18BPa indicated decreases in the gene expression of IFN- gamma and its regulatory molecules STAT-1 and STAT-2. This study pointed out that IL-18BPa has additional anti-inflammatory property through downregulating the expression of IFN- gamma and IL-12, at the same time, upregulating the expression of IL-4 and IL-10. Both IFN- gamma and IL-12 could upregulate the mRNA and protein levels of IL-18BPa in both the normal and RA subjects. Our results demonstrated the importance of IL-18BPa as an immune regulatory molecule and as a promising therapy for treating RA

Detection of serum prostate specific antigen in lactating, pregnant, and advanced breast cancer Sudanese women

Although prostate-specific antigen [PSA] is the most valuable tumor marker for the diagnosis and management of prostate carcinoma, it is widely accepted that PSA is not prostate specific. The aim of this study is to address the possibility of using the PSA as marker for the sex assignment in different categories and relevance of this test in women problems. We have evaluated the measurement of serum total PSA for differentiation between Sudanese women with advanced breast cancer [n= 10], and those lactating [n=10], pregnant [n= 10] compared with 20 healthy women as control group. Serum total PSA [TPSA] was measured using immuno-radiometric assay [IRMA]. In this study the mean age was significantly higher in advanced breast cancer groups compared with lactating group [P<0.01]. The mean serum PSA levels in the healthy control women examined [n=20] was 0.72 +/- 0.55 vs. 1.18 +/- 0.92, 1.42 +/- 2.43 and 0.51 +/- 0.13 ng/ml in serum from advanced breast cancer [n=10], pregnant [n=10] and lactating women [n=10] respectively. A significant high level of total PSA in serum of advanced breast cancer compared with the normal group [P< 0.05]. These results indicated the possible use of total PSA to distinguish between healthy women and/or women with advanced breast cancer

Changes in serum calcium, phosphate, albumin and parathyroid hormone before and after hemodialysis in Sudanese patients with end-stage renal failure

To determine the concentrations of serum parathyroid hormone [PTH] and bone minerals and their association before and after hemodialysis. A cross sectional study was done on patients with end-stage renal disease [ESRD] on treatment with maintenance hemodialysis [HD]. Levels of serum calcium, phosphate, urea, creatinine, albumin, and intact parathormone [iPTH] were measured. The total number of patients studied was 50 [40 males; 10 females], the mean age was 40.3 +/- 26.5 years, and the average duration on hemodialysis [HD] was 53 months. Serum PTH level was significantly lower after hemodialysis treatment; it was 945.8 +/- 995.9pg/ml and 781.7 +/- 928.1 pg/ml before and after HD respectively, but still over the normal range. Serum phosphate concentration was remarkably differ before and after HD [5.59 +/- 1.8 mg/ml vs 4.38 +/- 1.2 mg/ml respectively]. In contrast, the mean value of serum calcium concentration was changed significantly after HD [6.7 +/- 1.5 mg/dl] compared with the level before HD [5.6 +/- 6.7 mg/dl]. PTH correlated positively with phosphate [r=0.30, p=0.03], and negatively with calcium [r=-0.299, p=0.04] levels. A significant decrease in serum urea and creatinine levels was reported after HD. Serum albumin showed no significant difference before and after HD. PTH was remarkably decreased post dialysis in our patients with definite increased serum Ca[+]. There is no significant difference between PTH and patient's age, sex and duration in HD Sudanese patients

Semen analysis of infertile Sudanese males in Gezira state central Sudan

The aim of this study is to determine the major causes of infertility in Sudanese males based on the clinical and laboratory findings. The sample of 194 Sudanese males attending Gezira Hospital for Renal Diseases and Surgery, aged between 21-85 years were collected and analyzed. The method of masturbation after 3-5 days prior abstinence from sex before sample collection was applied. The samples were examined for semen volume, and microscopically as wet preparation for sperm motility, morphology and count. Of these men, 532% were primary infertile, while 46.8% were secondary infertile. The semen volume results showed that 89.7% were normal. In: the sperm morphology, 65.9% showed abnormal morphology. Azoospermia was present In 72 patients [37.1%], 13.4% had oligazospermia. This study reveals the main contribution of spernts abnormal morphology to infertility and it is important to abstain from sexual intercourse some days before collection of semen for analysis

Biochemical and clinical assessment of thyroid status in patients with thyroid disorders referred to El-Obied Regional Health Laboratory

This study aimed at assessing the thyroid status in Kordofan region [western Sudan] where the prevalence of goitre was not clearly defined. A cross-sectional, prospective study was conducted in Elobied regional health laboratory on 150 thyroid patients [136 female, 14 male] referred during the period between May-November 2003, their ages ranged between 6 to 65 years. A matching control group of 50 subjects [39 female, 11 male] without symptoms or signs of thyroid disease, were included for comparison. After clinical evaluation and data collection through a questionnaire, serum concentrations of TSH, total triiodothyronine [TT3], and total thyroxine [TT4] were measured by radioimmunoassay. The frequency of thyroid disorders was higher in females [90.7%] than in males [9.3%], among the age group between 25-34 years. The percentage of patients with euthyroid was significantly higher [62%] compared with 28.3% of hyper and 9.3% of hypothyroidism. 69.3% of the thyroid patients had stage II goitre. TT4, TT3 and TSH showed significant differences [P < 0.001] in hyper and hypothyroidism compared with the euthyroid patients and the control group. Serum TT[4] values correlated negatively with TSH [r = 0.272, P = 0.001], and positively with TT[3] [r = 0.693, P = 0.000]. The prevalence of thyroid diseases was found higher in this area, with strong association with the food intake and genetic background, a problem needing to be considered seriously

relationship between prolactin level and the duration of lactational amenorrhoea in lactating Sudanese women

This study aimed to assess the relationship between the prolactin [PRL] level and the duration of lactational amenorrhoea in lactating Sudanese women. Sudanese women [135] from Omdurman area with different ages [18- 41 years] and stages of lactation were included, 61 of them participated by giving venous blood samples and filling a questionnaire, while the others by filling the questionnaire only. Pregnant women, contraceptives users, and hypothyroid patients were excluded. The subjects were divided into lactational amenorrhoeic [Group I], and lactating menstruating subjects [Group II]. Then each group was subdivided according to the duration of lactation into: - Lactating for six months or less. Lactating for more than six months. Prolactin level was measured using radioimmunoassay [RIA]. In this study the mean prolactin level in-group I [2934.99 mU/L] was significantly higher compared with group II [707.46 mU/L] [P<0.05]. For the duration of lactation, PRL level in the first six months was higher [4414 mU/L], [1506.60 mU/L] in group I, and group II respectively, while this level decreased after six months [1538 mU/L], [517.19 mU/L] for the two groups. Also we found that factors like breast-feeding patterns, utilization of supplementary foods, and the number of parities had a significant effect on the duration of lactational amenorrhoea. There was a positive relationship between PRL level and the duration of lactational amenorrhoea [r=0.39]

Clinical and haematological findings in Sudanese patients with sickle cell disease attending the hospitals in Elobeid, Kordofan

This study aimed at assessing the clinical features and haematological parameters in sickle Sudanese patients attending El Obeid Hospitals in North Kordofan, Sudan. Eighty five patients with homozygous sickle cell [SS] disease, [both sexes] were included in this study. Their age ranged between 6 months to 42 years. Forty persons were used as control. Clinical manifestations were recorded at examination. Freshly obtained blood samples from patients and control were used to estimate haematological parameters which included: haemoglobin concentration [Hb], packed cell volume [PCV], red blood cell count [RBC], white blood cell count [WBC], mean corpuscular haemoglobin [MCH], mean corpuscular volume [MCV], and erythrocyte sedimentation rate [E.S.R]. The clinical investigations revealed that all patients presented with painful crisis, 96.5% had chronic anemia, 84.7% had recurrent malaria and 81.2% had different infections [76% was chest infection], 32.9% of the sickle cell disease [SCD] patients had no blood transfusion, while the rest had blood transfused once to five times. Haematological measurement indicate that all SCD patients in this study were reported anaemic, and their Hb, PCV and RBC count were significantly lower [P<0.001] compared with the control group, while WBC count of and MCV were significantly higher [P<0.001, P<0.01]. In this study the prevalence of SCD in Misseria tribe [24.7%] was highest compared to other tribes. This study affirmed the problem of sickle cell disease in Kordofan state, which should draw attention toward the need of further studies